| When an Alabama university decided it wouldย pause IVF treatmentsย after theย stateโs Supreme Courtย said thatย frozen embryos should be considered children, it was not the first time abortion politics interfered with access to fertility treatment.You see, a key tenet in the anti-abortion argument is that life begins when an egg and sperm meet. Those in favor of abortion access argue it starts later, when the fetus becomes viable. Thisย point of ideological contentionย is whyย state lawsย range from banning abortion atย six weeks after fertilization to allowing it up to 24 weeks of gestation (or, of course, outright banning it or having no cutoff at all).
When theย Alabama Supreme Court ruledย those who destroy frozen embryos are liable for wrongful death, they essentially fell back on an age-old anti-abortion argument:ย that a cluster of cells is a person as soon as sperm fertilizes anย egg.ย That meansย doctors who perform IVF procedures could end up being criminally prosecuted if, say, they disposed of embryos that arenโt viable โ those that have no chance of ever developing into a healthy person, or perhaps not even developing once implanted at all. Theย threat has the potential to shut down clinics that donโt want to face what could end up being a legal nightmare.
โThis really does mean that IVF is likely to become completely inaccessible in the state,โย Katie OโConnor, director of federal abortion policy at the National Womenโs Law Center,ย told my colleagues.ย Abortion politics have been intertwined with fertility treatment in the US since before theย very first IVF babyย was born in the UK in 1978. In a sense, IVF and the anti-abortion movement grew up together.
In the 1970s, as scientists around the world were racing to figure out how to make a viable embryo in a Petri dish, the Roe v. Wade decision had just kicked the anti-abortion movement into high gear. Anti-abortion activists argued that life began when sperm and eggs combined. It didnโt matter whether that conception was in a person or a Petri dish.ย This turned IVF research into a lightning rod, as Rutgers University historianย Margaret Marsh and herย sister Wanda Ronner, a gynecologist, chronicle in their bookย The Pursuit of Parenthood.โIn 1979, a year after the birth of the worldโs first IVF baby, a coalition of anti-abortion organizations denounced IVF in an ad in the New York Times as a โmorally abhorrentโ technology, and they successfully thwarted all efforts to allow federal funding for any research using human embryos,โย Marsh told me via email.
Fear of political blowback interfered with the US weighing in on IVF.ย When a federalย ethics advisory board eventually issuedย support for it,ย someย 13,000ย people sent in public comment, most of them in opposition. Aย moratorium on funding research involving embryos remained in effect. And federal funding typically fuels new basic research. That meant that even as scientists in countries like Australiaย and the UK were making breakthroughs that would eventually help people suffering from infertility start families, in the USย the leading scientists who wanted to do IVF research werenโt pursuing it.ย Whenย it became clear that IVF was too lucrative and important for US clinics not to even try, private funding stepped in to bring it to America.ย The first US IVF babyย was born in 1981ย at the teeny, little-known Eastern Virginia Medical School. Anti-abortion activists protested the clinic. But, asย Marsh explained it to me, the schoolย was just five years old, so it didn’t have an established reputation to lose or an existing stream of federal research dollars at risk.
The market opportunity for IVF was โ and is โ huge. Today,ย one in sixย people are impacted by infertility, according to the World Health Organization. And eventually the market won out over the politics. The number of assisted reproductive technology procedures โ includingย IVF โ was 413,776 in 2021, up 78% from 2015, according to theย Centers for Disease Control and Prevention.ย The global fertility market is expected to balloon to $84 billionย by 2028, according to market research firm Imarc.
โOver the years, the anti-abortion movement gradually accepted some reproductive technologies, as long as no embryos were destroyed during their use,โ Marsh told me. โBut the peace it made with the new technologies was always an uneasy peace.โThatย early dissent from anti-abortion activistsย had a lasting impact on the way the industry took shape โ it is part of why, for so many people,ย IVF is difficult to access.ย Several early Congressional attempts to regulate the IVF industry failed, leaving clinicsย to come up with protocols and procedures on their own. Without any sort of official endorsement for fertility treatment, few states enacted mandates to cover it and insurers in those states felt no pressure to cover the expensive procedure.ย Still today,ย most statesย do not require private insurers to offer fertility benefits. Onlyย 43% of large US employersย offered IVF coverage in 2022.ย IVF is impossible for most people to afford, typically costing upwards of $10,000 per cycle.ย So market forces mean clinics are largely clustered in wealthier regions where there are more patients who can pay for it. Now political forces stand to put IVF even further out of reach.ย โย Kristen V. Brown |
